BMJ  2005;331:1416 (10 December), doi:10.1136/bmj.331.7529.1416

Minerva

After analysing data from their freephone helpline, the cancer information charity, CancerBACUP, say that over 75% of all calls they receive are from women, and over 25% of calls are about breast cancer. The data have also been used to identify the extent to which specific groups of people do or do not use the service, and to measure the effectiveness of strategies used to try to increase the number of enquiries from specific groups. To find out more about access to cancer information, go to www.cancerbacup.org.uk/Aboutus/Research.

A five year follow-up of a comparison of bare metal coronary artery stenting with minimally invasive bypass surgery for isolated stenosed left anterior descending coronary arteries reports similar results for the end points of death and re-infarction. Reintervention rates, however, were higher after stenting (32% compared with 10%; P < 0.001), and symptom relief was slightly better after surgery (Circulation 2005;112: 3445-50[Abstract/Free Full Text]).

A double blind placebo controlled trial involving 120 people who had tinnitus but not depression, examined whether a selective serotonin reuptake inhibitor (paroxetine) could relieve symptoms. Paroxetine (and placebo) was increased to a maximally tolerated dose, and patients were treated for 31 days at this dose. The active drug proved no more effective than placebo, but when answering the question "how aggravating is your tinnitus?" those who had been taking paroxetine improved significantly more than those taking placebo (Psychosomatic Medicine 2005;67: 981-8[Abstract/Free Full Text]).

Rigorously conducted trials suggest that dark chocolate has a positive effect on blood pressure, but what effect does cocoa consumption have in a free-living population? A dynamic cohort of Spanish university students helped assess the association between eating chocolate and hypertension. Overall, chocolate consumption was not associated with the risk of hypertension, but the researchers say that the kind of chocolate eaten by the general public tends to be low in flavonols and cocoa—and the frequent snacking that goes hand in hand with eating chocolate can lead to obesity, which probably counteracts any beneficial effects of dark chocolate (Hypertension 2005;46: e21-2[Free Full Text]).

People who have cluster headaches often experience cranial autonomic symptoms that are thought to arise from intense trigeminal nerve (ophthalmic division) pain. Of 17 patients who underwent transection of the trigeminal nerve root, five continued to experience cranial autonomic symptoms without pain, and another group of five continued to get cluster headaches. These observations suggest that cluster headaches are generated by a central pacemaker and that pain can be expressed without the activation of the trigeminal vascular network (Neurology 2005;65: 1650-1[Abstract/Free Full Text]).

The media are often castigated for inaccurate medical messages, but sometimes they get them right. A Canadian television documentary in 2003 seems to have changed prescribers' behaviour more effectively than a drug company letter to all health professionals or a printed warning in the CMAJ. The programme had two messages: that Diane-35 (Dianette in the United Kingdom), a second line hormonal treatment for acne, was associated with venous thromboembolism, and that doctors were wrongly prescribing it off-label as an oral contraceptive (CMAJ 2005;173: 1313-5[Free Full Text]).

Examination of scalp hair samples under a light microscope can help in the diagnosis of quite obscure paediatric disorders. A review from one specialist paediatric pathology department describes it as a cheap, rapid, and non-invasive method of diagnosing disease: it can pick up Menkes disease, Netherton's syndrome, trichothiodystrophy, Griscelli and Chediak-Higashi syndromes, monilethrix, loose anagen syndromes, and uncombable hair. Minerva confesses that she's heard of none of these except for the last (Journal of Clinical Pathology 2005;58: 1294-8[Abstract/Free Full Text]).

A woman presented to the eye casualty department with a corneal ulcer related to contact lens wearing. She had been treated for four days with a newly available over the counter preparation of chloramphenicol. The drops had been recommended by three consecutive pharmacies, but the first two had been unable to dispense them because they had none in stock. However, guidance issued by the Royal Pharmaceutical Society of Great Britain states that contact lens wearing is a contraindiction to over the counter prescribing without referral to a doctor or optician. If topical antibiotics that are readily accessible are to be dispensed safely, all pharmacists must be aware of limitations and restrictions. Andrew David Shaw (shawry{at}arcticmail.com), senior house officer, Sarah Meredith, specialist registrar, ophthalmology department, Norfolk and Norwich University Hospital, Norwich NR4 7UY

Treating chronic rhinosinusitis with oral terbinafine doesn't work. In a double blind placebo controlled study, oral terbinafine failed to make any impact on symptoms or x ray appearances, even when nasal irrigation samples were positive for fungus on culture. It's possible that the fungal element was not a pathological factor, or perhaps it's just that even at high doses, terbinafine levels weren't maintained in the nasal secretions (Laryngoscope 2005;115: 1793-9[CrossRef][ISI][Medline]).

It may sound like common sense, but if you want to avoid frostbite you should take to the mountains with appropriate clothing, take the necessary equipment (such as good quality boots and mittens), and use a competent guide. You should also avoid wet clothing and windy terrains and never remain in the same position for long periods. Mountaineers have more cold injuries than the general public, and it's usually because they fail to take their sport seriously (British Journal of Sports Medicine 2005;39: 898-901[Abstract/Free Full Text]).

Celery seed (Apium graveolens) holds remarkable repellent qualities in the laboratory and the field, and it's been found to work against a variety of mosquito species. A study in Tropical Medicine and International Health ( 2005;10: 1190-98)[CrossRef] says it compares well with 15 commercial mosquito repellents, including the one that is most widely used, DEET. Hexane extracted A graveolens didn't burn or irritate human skin, and there were no adverse effects during the six months of the study. The authors say it may be a good alternative to synthetic chemicals.

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